Abstract
Background. Subclinical hypothyroidism (SH) predominantly affects women. The necessity of treatment in SH is controversial. Objective. We aimed to investigate the response of diastolic dysfunction to thyroid hormone replacement therapy (THRT) in women. Methods and Results. Twenty-two female subjects with SH and 20 euthyroid female controls were enrolled. Baseline and follow-up biochemical, hormonal, and echocardiographic evaluations were performed. Repeat echocardiograms were performed three months after the achievement of a euthyroid status with THRT. Mean baseline myocardial performance index (MPI) was 0.27 ± 0.08 in the SH group, and 0.22 ± 0.06 in the control group (P = 0.03). MPI did not change significantly after THRT. Pulsed-wave Doppler findings were not different among the groups. However, tissue Doppler-derived mitral annular E' velocities were significantly lower in the SH group. A moderate but significant improvement was observed in E' velocities after THRT (13.2 ± 3.87 versus 14.53 ± 2.75, P = 0.04). We also observed left ventricular concentric remodeling in SH patients which was reversible with THRT. Conclusions. Tissue Doppler echocardiography may be a useful tool for monitoring the response of diastolic dysfunction to thyroid hormone replacement therapy in patients with SH. Our findings suggest that THRT may reverse diastolic dysfunction in women with SH.
Highlights
Subclinical hypothyroidism (SH) is a generally asymptomatic condition defined as normal serum levels of thyroid hormones and elevated thyroid stimulating hormone (TSH) levels
Previous studies concerning the cardiovascular effects of SH have shown a decrease in pre-ejection period (PEP) and PEP/LVET ratio which is reversible with T4 replacement therapy [4,5,6]
The generally accepted opinion is that treatment can be started to prevent progression to manifest hypothyroidism or to alleviate symptoms if they are present [22]
Summary
Subclinical hypothyroidism (SH) is a generally asymptomatic condition defined as normal serum levels of thyroid hormones and elevated thyroid stimulating hormone (TSH) levels. Left ventricular systolic function is normal at rest but impaired during exercise in patients with SH when compared to euthyroid controls [7,8,9]. Exercise-induced systolic dysfunction has been attributed to diastolic dysfunction at rest; the impairment of left ventricular relaxation may lead to impaired. We aimed to investigate the response of diastolic dysfunction to thyroid hormone replacement therapy (THRT) in women. We observed left ventricular concentric remodeling in SH patients which was reversible with THRT. Tissue Doppler echocardiography may be a useful tool for monitoring the response of diastolic dysfunction to thyroid hormone replacement therapy in patients with SH. Our findings suggest that THRT may reverse diastolic dysfunction in women with SH
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